Shared Decision Making to Improve Palliative Care in the Nursing Home Abstract Twenty-eight percent of Americans over the age of 65 die in a nursing home. Research has found the quality of care of end-of-life care in nursing homes to have many challenges. It has also been documented that family members, especially those living at a distance, want to be involved in the care of their resident and family support can be beneficial to residents. Family members' involvement in decision-making in the nursing home setting improves outcomes for residents with life-limiting illnesses. Shared decision-making is a process wherein a healthcare choice is jointly made by a healthcare provider and a resident or resident's proxy (14, 15), often a family member. This proposal seeks to facilitate SDM among family members, residents with life- limiting illnesses (who are not enrolled in hospice), and the nursing home care team. Our overall research question (RQ) asks: To what extent are outcomes for family member and residents with life limiting illnesses associated with SDM via web-conferencing in the nursing home? Our overall hypothesis (H) is that SDM among family members, residents (when possible), and skilled nursing home staff via web- conferencing will improve outcomes for family members and residents with life-limiting illnesses. We propose exploratory mixed methods randomized clinical trial pilot to test the effect of shared decision making using web-based conferencing on the depression and burden of family members and the pain of nursing home residents. We seek to translate our hospice experience with web-conferencing and shared decision making into the nursing home setting with geriatric residents appropriate for palliative care.